Radiofrequency Ablation (RFA)

  • Radiofrequency Ablation (RFA) is a procedure commonly used to close diseased veins after an ultrasound has confirmed damaged veins
  • Damaged veins become very large, swollen, and can be painful. The small valves inside no longer keep blood traveling one way, upwards and back to your heart
  • This causes blood to flow backwards and “pool” inside the veins in your legs. Sometimes fluid can leak out of the vein and collect under the skin causing swelling
  • The most common treatment for varicose veins (also known as Venous Insufficiency) is an Ablation: a procedure in which the vein is heated, becomes irritated, and closes down

The Procedure: Radiofrequency Abalation (RFA)

Here is how it works:

  • First, your leg is cleansed with Betadine solution to “sterilize” the skin
  • We are able to see your veins using an ultrasound machine during the entire procedure
  • Numbing medication is injected beneath the skin, over the vein, at or below the knee
  • A VERY small incision is made to allow for easy entrance of the sheath and catheter into your vein (a sheath is a “straw-like” tube which holds your vein open and supports the catheter while it is in your vein)

A small injection is made to numb the skin before the vein is accessed – this is called a “Sheath”

  • Next, the catheter is inserted through the sheath and into your GSV vein

  • Our veins “live” inside a compartment fibrous sheath called the “fascia”

Picture: needle puncturing the fascia and delivering the numbing saline solution to cushion the vein.

  • Local anesthetic (numbing) solution called “Tumescent” (too-mess-sent) is injected into this compartment around the entire length of the vein to cushion the vein and protect surrounding tissues from the heat of the catheter during treatment
  • Injecting the fluid is not usually painful. You may occasionally feel a few small needle pricks. You will feel pressure from the fluid buildup under your skin, but these sensations are completely harmless.
  • Next, energy is delivered to the catheter which heats the catheter tip and gently destroys the lining of the vein

  • YOU WILL NOT FEEL ANY HEAT
  • You will feel pressure as we apply light pressure to your leg over the vein while the catheter is delivering heat
  • The vein closes in response to inflammation and damage from the heat
  • This procedure closes the diseased vein. It does not remove the vein
  • The procedure usually takes 30 minutes depending on the severity of your disease

The Day of Your Procedure

Wear loose fitting clothing and easy to slip on shoes. Your leg will be wrapped after your procedure and dressings can be bulky

Take your usual morning medications EXCEPT: (Do not take Blood Thinners for 2 Days)

  • Warfarin (Coumadin)
  • Eliquis
  • Brillinta
  • Pradaxa
  • Xarelto

You will need to discuss stopping your blood thinner with your primary care physician

  • Let us know if you are on a water pill (example: furosemide (Lasix), hydrochlorothiazide)
  • NOTIFY US IF YOU TAKE:  CLOPIDOGREL (PLAVIX) or CILASTAZOL (Pletal)
  • DRINK PLENTY OF WATER THE DAY BEFORE AND 2 HOURS BEFORE YOUR PROCEDURE
  • NO alcoholic beverages for 48 hours before your procedure
  • STOP WEARING COMPRESSION STOCKINGS 3 days before your procedure (unless you have been told different in our office)

After your procedure

  • You must walk for 20 minutes after your procedure
    • You will need to walk 3 times a day or 30 minutes total every day for the next 2 weeks
    • Your legs will be wrapped with gauze (due to the numbing saline solution which may leak from your pores) and we will put a compression wrap over the gauze
    • REMOVE THE COMPRESSION WRAP, GAUZE, and any bandage strips 24 HOURS AFTER YOUR PROCEDURE
    • You can shower in 24 hours.  
  • Do not soak in a tub, hot tub, or pool for 2 weeks after your procedure
    • After showering, gently pat the area dry and try to avoid lotions for 2 weeks
  • Wear compression stockings to the treated leg(s) for 3 months after the procedure
  • Take compression stockings off at night and to shower
  • Avoid sitting or standing for prolonged periods (no more than 30 minutes then change position)
  • Avoid heavy lifting, nothing over 15 pounds, for 5 days
  • You can return to work. There is NO downtime unless your job requires you lift objects over 15 pounds
    PLEASE NOTE:  A FOLLOW UP ULTRASOUND IS REQUIRED 2-5 DAYS AFTER EACH VEIN IS TREATED TO CONFIRM THE VEIN IS CLOSED AND THERE IS NO BLOOD CLOT

Common Side Effects After RFA

  • Most patients recover from Radiofrequency Ablation and Foam Sclerotherapy without any problems.
  • It is normal to feel a tightening sensation in your leg after a couple of days, which may last for several days.
  • It is also common to experience cramping, bruising and swelling.
  • The vein will become tender after we “anger” it with heat.  
    Typically, between days 3 to 14 the vein can be tender, sore, or painful.
  • There may be a sensation of “pulling” or “tugging”
  • The vein or the valves inside the closed vein may become hard or feel “knotted”
  • IF YOUR PRIMARY CARE PHYSICIAN TELLS YOU THAT YOU CAN TAKE OVER-THE-COUNTER Non-Steroidal Anti-Inflammatory Drugs also referred to as NSAIDS (Motrin, Ibuprofen, Advil, Naproxen, etc):  We recommend you take IBUPROFEN 400mg once in the morning and 400mg once at night for 2 weeks after your procedure

    *Ask your Primary Care Physician if you are unsure whether you can take NSAID medications!
    If you use NSAIDs for a long time, or if you take large doses, there are chances to have side effects like stomach upset, heartburn, ulcers and skin rashes

Side Effects
If nerve damage occurs along the treated vessel, you may experience a tingling or prickly sensation afterward. This typically resolves in 4-6 weeks.
It is rare, but this can last months or years.

Other possible side effects include:

  • Tenderness
  • Burning
  • Localized bruising

No matter how small the incision, infection is a possibility, so remember to keep the area clean and dry!

AVOID fancy or highly perfumed soaps, long soaking in the bath or lounging in a hot-tub!

If you have swelling after your procedure, simple measures such as:

  • Leg elevation
  • Ice packs
  • Ibuprofen to treat swelling and alleviate discomfort associated with phlebitis

Deep venous thrombosis or blood clots are always a concern after any medical procedure.

Remember, wearing your compression stockings and sticking with a walking regimen helps reduce clot formation.
If you are experiencing any sensations that are unfamiliar or unpleasant, your Vein Specialist is a phone call away!

After All Veins Have Been Treated
You will have a final ultrasound and a follow up appointment 6 weeks after the last vein has been treated.

Your FINAL office appointment will occur at 3 months. This is a quick visit which provides the opportunity for us to see how you are doing and to determine if you are still having pain or swelling in your legs which may require further evaluation.